Objective: To compare the treatment effect of distraction osteogenesis (DO) and maxillomandibular advancement (MMA) for severe obstructive sleep apnea hypopnea syndrome (OSAHS) patients and to guide clinical decisions about treatment of OSAHS. Methods: Thirty-seven OSAHS patients which accepted maxillomandibular advancement (MMA) or distraction osteogenesis (DO) in Stomatological Hospital of the Department of Maxillofacial Trauma and Orthognathic Surgery, School of Stomatology, The Forth Military Medical University from June 2017 to June 2019 were collected. Their preoperative and postoperative data of cephalometry, polysomnography (PSG), Pittsburgh sleep quality index (PSQI) and Epworth sleepiness scale (ESS) scores were collected and analyzed. With propensity score matching method, the treatment effect of MMA and DO was analyzed and compared. Results: According to the statistics of MMA group, only AHI was correlated with operative successful rate and cure rate. With the increase of AHI, the treatment effect of MMA on OSAHS patients gradually decreased. The cut-off point of AHI as a predictor of MMA treatment failure was 78.2 n/h. All the matched cases were severe OSAHS patients. Statistical analysis showed that the mandibular elongation of DO patients[(24.00±4.39) mm] was significantly more than that of MMA group [(11.20±1.37) mm] (t=-6.11, P<0.001), the improvement of PSG index [including lowest oxygen saturation (LSpO₂), longest apnea (LA) and longest hypopnea (LH)] in DO group [LSpO₂=(93.40±1.82)%; LA=(18.28±8.32) s; LH=(61.84±32.94) s] was significantly higher than that in the MMA group [LSpO₂=(86.00±4.06)%, LA=(64.08±21.78) s, LH=(172.40±30.70) s](t=-3.72, P=0.005; t=4.39, P=0.003; t=5.49, P=0.004). The PSQI and the ESS scores of DO group (PSQI=4.20±0.83; ESS=3.40±1.52) were also significantly better than that of MMA group (PSQI=8.80±2.39, ESS=9.40±2.88)(t=4.07, P=0.001; t=4.12, P=0.002). Conclusions: For severe OSAHS patients, the objective and subjective indicators of DO treatment group showed a better therapeutic effect than that of MMA.
Humans ; Mandibular Advancement ; Osteogenesis, Distraction ; Retrospective Studies ; Sleep Apnea, Obstructive/surgery* ; Treatment Outcome

Objective To clarify which adenosine receptor subtype is the most powerful one on controlling retinal pigment epithelial cell (RPE) binding adenosine, and what is its function in RPE. Methods Total mRNA was isolated, and membrane protein was extracted from in vitro cultured human ARPE-19 cells. For all four kinds of adenosine receptors, ARA1, ARA2A, ARA2B and ARA3, their gene expressions were tested by real-time PCR while their molecules in the membrane protein were detected by Western blot assay. To check the influence of each adenosine receptor subtype on ARPE-19 cell binging ability to adenosine the cultured cells were divided into five groups, named A-E. A group was set up as untreated control, while, groups B-E were separately treated by ARA1 agonist DPCPX (50 nmol/L), ARA2A agonist SCH58261 (100 nmol/L), ARA2B agonist MRS1754 (100 nmol/L) or ARA3 agonist MRS1220 (5μmol/L). H3-adenosine a radioactive ligand binding assay was performed and the maximum binding capacities (Bmax) were calculated in groups A-E of ARPE-19 cells. Then, ARPE-19 cells were all treated by the combination of TNF-αand IFN-γbut with or without CCPA (100 nmol/L), an ARA1 agonist. MCP-1, IP-10, IL-6, IL-10 and TGF-β in their mediums were determined by ELISA. Results Either mRNA expression or membrane localization of ARA1, ARA2A, ARA2B and ARA3 were verified by real-time PCR and Western blot assay respectively. For A-E groups of ARPE-19 cells the Bmax of adenosine binding were (2.04± 0.31), (0.44 ± 0.06), (1.82 ± 0.28), (2.01 ± 0.42) and (2.06 ± 0.44) fmol respectively;and which were statistically decreased in group B than those of all other groups (P<0.01). Compared with control RPE, the contents of IL-6, MCP-1 and IP-10 were decreased after treatment with CCPA, and the content of IL-10 increased in RPE group (P<0.01). There was no significant difference in TGF-β content between the two groups. Conclusion APRE-19 cells predominantly use ARA1 to absorb adenosine, and the activation of ARA1 in ARPE-19 cells inhibits its IL-6, MCP-1, and IP-10 production, which have potentially immunosuppressive effects to APRE-19 cells.

OBJECTIVETo evaluate the efficacy and safety of anti-interleukin-17 antibody in the treatment of plaque psoriasis.

METHDOSRandomized controlled trials (RCT) of anti-interleukin-17 antibody (Secukinumab, Brodalumab, and Ixekizumab) in the treatment of plaque psoriasis published between January, 2000 and March, 2017 were searched from PubMed, Cochrane Library, EBSCO, EMbase, CBM, CNKI, VIPdetabase, and Wangfang database. The quality of the retrieved trials was evaluated and the results of studies were analyzed using RevMan 5.0 software.

RESULTSThirteen RCTs were included involving a total of 11 203 patients. Meta-analysis showed a significant differences between anti-interleukin-17 antibody and placebo (or positive drug) in terms of PASI75 and sPGA (P<0.05). The total incidence of adverse events differed significantly between anti- interleukin-17 antibody and placebo, but no significant differences were found between them in the incidence of serious adverse events and discontinuation rate due to adverse events (P>0.05).

CONCLUSIONAnti-interleukin-17 antibody is safe and effective for treatment of plaque psoriasis.

Objective Objective To evaluate the efficacy and safety of Reinhartdt and Sea Capsule (RSC) combined with donepezil (experimental group) compared with donepezil (control group) in treatment of Alzheimer's disease.Methods The randomized controlled trials (RCT) of reinhartdt and sea capsule combine with donepezil in treatment of Alzheimer's disease were searched from Pubmed,VIP,CNKI,CBM,and Wangfang detabase by computer.Deadline from January 2000 to February 2017.References of included studies were also retrieved,extracted data,and assessed the methodological quality.Then,Meta-analysis was performed using RevMan 5.0 software.Results A total of eight RCTs were included,including 605 patients with insomnia.Meta-analysis results showed that compared with control group,experimental group MMSE score [P＜0.001,MD=2.69,95％CI(1.46,3.92)],ADAS-Cog score [P＜0.001,MD=-4.54,95％CI(-5.64,-3.43)] and ADL score [P＜0.001,MD=-3.60,95％CI(-4.53,-2.66)],the difference was statistical;There was no signficant difference between two group in the incidences of adverse effect [P=-0.94,OR=1.02,95％CI(0.63,1.66)].Conclusion RSC combined with donepezil showed better efficacy for Alzheimer's disease,yet without increasing adverse effect rate as compared with donepezil alone.

An optimal therapy for pulmonary embolism (PE) was explored by comparing three different methods in order to alleviate the sufferings of PE patients and reduce the mortality. Eighty patients with PE diagnosed by computed tomography angiography (CTA) were treated with thrombolysis, anticoagulation only, or surgery/intervention. The clinical efficacy of different treatments were compared and analyzed. Twenty-four out of the 26 patients (92%) in anticoagulation only group showed improvement in CTA and clinical presentations, which was significantly higher than that in the thrombolysis group (87%, n=39, P<0.05). However, there was no significant difference in the rate of mortality between thrombolysis group and anticoagulation only group. In the surgery/interventional group (n=15), the success rate was 47%, and the mortality rate was 14%. Both of them were significantly different from those in thrombolysis and anticoagulation only groups (both P<0.05). Log-rank analysis of the data of 5-year follow-up revealed that the survival time in surgery/intervention group was significantly shorter than in the other two groups (P<0.05). It was suggested that it is of importance to choose the appropriate therapeutic regimen for PE patients. Mortality may be reduced and prognosis may be improved with anticoagulation only and thrombolysis therapy.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anticoagulants ; adverse effects ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Pulmonary Embolism ; drug therapy ; surgery ; Pulmonary Surgical Procedures ; adverse effects ; Survival Analysis ; Thrombolytic Therapy ; adverse effects

Objective To establish an accurate method for estimating the indoor gamma dose rate from decorative stones.Methods Combining a room model with decorating conditions,the gamma dose rates and dose rate conversion factors (DCF) at 1 m above the floor in the room center were calculated with the Monte Carlo simulations,and the calculation results were verified through experiments.Based on the results,the limit of radionuclide contents in stone materials was further discussed.Results The DCF increases with the increase of area or thickness of decorative stones in the same room.The increase of DCF with the thickness of decorative stone is approximately linear.The DCF also increases with the area of decorative stones,but the increasing trend slows down.For the same decorative stones,the smaller the room,the larger the increase of gamma dose rate.Experimental results were consistent with the simulation results within ± 20％.Conclusions The increase of indoor gamma dose rate depends not only on the radionuclide contents,but also on the area and thickness of the decorative stones as well as the room size.The method used in this study can be used to estimate,more accurately than ever,the additional external exposure to residents due to decorative stones,and it provides a theoretical basis for revising the limit standard on radionuclide contents in decorative materials.

Objective This paper explored the effect of the early clinical exposure in im-proving medical students' cognitive aspects of the doctor-patient relationship. Methods (1)From 280 undergraduate students of Grade 2010 who participated in early clinical exposure of Xi'an Jiaotong University College of Medicine and 280 undergraduate students of Grade 2011 who did not participate in the early clinical exposure, we selected 140 students respectively to conduct a simple random sam-pling survey. The results were analyzed by SPSS after using Microsoft Excellsoftware for entry. Statis-tical methods selected χ2-test/Fisher exact test(P<0.05). (2)We had an interview to students,teachers leading the project, instructor,experts engaging in the study of the doctor-patient relationship by using focus group discussion and in-depth interview, and then using thematic analysis to analyze the data. (3)The main aspects of questionnaires and interviews were: details, activity participation/interest, general cognitive on the doctor-patient relationship, passion for profession, choice of career, the effect in improving medical students' cognitive aspects of the doctor-patient relationship and the suggestions and comments. Results The effective questionnaires collected from Grade 2010 were 134, and124 from Grade 2011.The participation rate of the undergraduates of Grade 2010(participating group) was 94.0%(126/134), while the interest rate of undergraduates of Grade 2011 (control group) was only 76.6%(95/124). Participating group had a better cognitive understanding of doctor-patient relationship than control group(P=0.0192). The activities had significant effects on choice of career(P=0.0002), and no effect on passion for profession(P=0.7372). There was statistically significant difference on their views of employment(P=0.0002). The key words for the interview were: not enough preparation before activity, not reasonable timing, teachers leading the project, stimulation of professional pride. Conclusions Early clinical exposure activities can be effective in improving medical students' awareness of the current doctor-patient relationship. Still we have some shortages in the activity, some more exploration and amelioration should be made in late stage.

OBJECTIVETo study the effects of E2F-1-silencing lentivirus vector on the growth and chemoresistance of subcutaneous human gastric cancer in nude mice.

METHODSThirty-six nude mice were inoculated subcutaneously with chemoresistant SGC-7901/DDP cells to establish subcutaneous tumor models of gastric carcinoma. The mice were randomly divided into E2F-1/RNAi-LV group, LV-scrRNAi group and PBS group (n = 12). E2F-1/RNAi-LV, LV-scrRNAi or PBS (0.1 ml per time) was injected into the mice, respectively, every two days. The nude mice received an intraperitoneal injection of cisplatin (25 mg/kg) every two days. The tumor volume was measured and histopathological changes of the tumors were observed by HE staining. The expressions of E2F-1, c-Myc, survivin, MDR1 and MRP were detected by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) and Western blot. Apoptosis in tumor xenografts was determined by in situ TUNEL labeling technique.

RESULTSThe mean tumor growth rate of the E2F-1/RNAi-LV group was significantly slower than that of the LV-scrRNAi and control groups (P < 0.05). The tumor volume of the E2F-1/RNAi-LV group was (745.13 ± 154.42)mm(3), significantly lower than that of the LV-scrRNAi and PBS groups (P < 0.05). Compared with that in the LV-scrRNAi and PBS groups, the expressions of mRNA and protein of E2F-1, c-Myc, survivin, MDR1 and MRP were significantly decreased in the E2F-1/RNAi-LV group (P < 0.05). The apoptotic rate in the E2F-1/RNAi-LV treatment group was (27.5 ± 9.7)%, significantly higher than (7.0 ± 1.1)% in the LV-scrRNAi group and (7.3 ± 1.2)% in the PBS group (P < 0.05).

CONCLUSIONIntra-tumoral injection of E2F-1/RNAi-LV shows significantly inhibitory effect on the tumor growth and chemoresistance of subcutaneous human gastric cancer in nude mice.

ATP-Binding Cassette, Sub-Family B, Member 1 ; genetics ; metabolism ; Animals ; Antineoplastic Agents ; pharmacology ; Apoptosis ; Cell Line, Tumor ; Cisplatin ; pharmacology ; Drug Resistance, Neoplasm ; E2F1 Transcription Factor ; genetics ; metabolism ; Female ; Gene Silencing ; Genetic Vectors ; Humans ; Inhibitor of Apoptosis Proteins ; genetics ; metabolism ; Lentivirus ; genetics ; Mice ; Mice, Nude ; Multidrug Resistance-Associated Proteins ; genetics ; metabolism ; Neoplasm Transplantation ; Proto-Oncogene Proteins c-myc ; genetics ; metabolism ; RNA, Messenger ; metabolism ; Random Allocation ; Repressor Proteins ; genetics ; metabolism ; Stomach Neoplasms ; genetics ; metabolism ; pathology ; Transfection ; Tumor Burden

Objective To investigate the impact of prior cerebral infarction (PCI) on in-hospital mortality in patients with Acute Myocardial Infarction (AMI).MethodsA retrospective analysis of documents of a total of 3572 consecutive patients with AMI admitted to Xuanwu Hospital of Capital Medical University from 2002 Jan.1 to 2009 Dec.31 were performed.Results There were 564 patients ( 15.8% )with PCI.Compared with the group of without PC1,the group with PCI were substantially older[(69.4 ±9.9) vs (64.2 ± 12.9)years,P =0.000],and had a higher prevalence of hypertensive disease,diabetes mellitus,prior myocardial infarction (MI) and non-ST-segment elevation myocardial infarction(NSTEMI)( respectively,71.0% vs 57.3%; 41.0% vs 25.7%,12.9% vs 9.5%; 14.9% vs 10.7%,P ＜ 0.01 ),and a higher in-hospital mortality ( 16.5% vs 10.0%,P= 0.000).Univariate analysis demonstrated that in-hospital mortality associated with age,gender,extensive anterior MI,anterior MI,diabetes mellitus,prior cerebral infarction,prior myocardial infarction,coronary angiography and percutaneous coronary intervention.Logistic regression analysis found that risk factors were age,extensive anterior MI,anterior MI,diabetes mellitus and prior cerebral infarction,and protective factors were coronary angiography and percutanous coronary intervention.PCI was independently associated with in-hospital mortality,OR 1.368,95% CI 1.047-1.787,P = 0.022.Conclusion In patients with acute myocardial infarction,the presence of PCI increases the risk of worse in-hospital outcome.